University of Groningen, and Department of Cardiology, Thoraxcenter, University Hospital of Groningen, Groningen, the Netherlands.
Neuromodulation. 2011 Jan;14(1):13-8; discussion 18-9. doi: 10.1111/j.1525-1403.2010.00321.x. Epub 2010 Dec 13.
Patients suffering from severe chronic angina pectoris (AP) that has become therapeutically refractory to medication and revascularization can be adequately treated with spinal cord stimulation (SCS). However, following SCS implantation for angina, not all patients show a consistent improvement in quality of life (QoL). Therefore, we sought to study the association of baseline characteristics and chronic multimorbidities on QoL following SCS implantation.
All patients treated with SCS for refractory AP (rAP) were registered in a local data base. Patients who had discontinued SCS therapy were excluded from further analysis. Baseline characteristics, such as exercise limiting morbidities (chronic obstructive pulmonary disease [COPD], rheumatic disease, diabetes mellitus [DM], obesity expressed as body mass index [BMI]>25) and demographic data, were retrieved from the data base. QoL was studied using the Seattle Angina Questionnaire and the RAND-36 questionnaire.
During a 21-year registration period (1986-2008), we enlisted 127 patients with SCS for rAP in our data base. Eighty-two, of whom 59 died, had discontinued SCS and were lost to follow-up. Out of the remaining 45 patients, 33 returned their questionnaires (73.3%). At SCS implantation, 72.7% of the patients were male, mean age 58±8.5 years. Twenty-four patients were in class III-IV angina and nine in class II-III NYHA. After a follow-up of 6.4±4.1 years, men had better physical capacity and experienced less impairment in QoL resulting from physical or emotional restrictions (all p<0.05) compared with women. Patients without COPD reported a better general health compared with those with rAP and COPD (p<0.05). The association of DM on QoL was borderline significant. Patients with lower BMI scored better on emotional well-being and perception of disease than those with a higher BMI (p<0.05 and p<0.05, respectively). None of the patients reported other morbidities limiting their exercise.
Men showed a larger improvement in QoL following SCS implantation, compared with women. As SCS improves rAP, other chronic morbidities such as COPD, DM, and BMI may become the limiting factors for exercise and subsequently adversely affect QoL following implantation of an SCS system. As a consequence of the present relatively small single-center study, we recommend studies regarding rAP and SCS to also address the effect of comorbidities on outcomes.
对于药物和血运重建治疗均无效的严重慢性稳定性心绞痛（AP）患者，可以通过脊髓刺激（SCS）进行有效治疗。然而，并非所有接受 SCS 治疗的心绞痛患者在生活质量（QoL）方面都能得到一致改善。因此，我们旨在研究 SCS 植入术后基线特征和慢性合并症与 QoL 的相关性。
所有接受 SCS 治疗难治性 AP（rAP）的患者均在当地数据库中进行登记。剔除了停止 SCS 治疗的患者。从数据库中提取基线特征，如运动受限合并症（慢性阻塞性肺疾病[COPD]、风湿性疾病、糖尿病[DM]、BMI>25 的肥胖）和人口统计学数据。使用西雅图心绞痛问卷和 RAND-36 问卷研究 QoL。
在 21 年的登记期间（1986-2008 年），我们将数据库中的 127 名接受 SCS 治疗 rAP 的患者纳入研究。其中 82 名患者因停止 SCS 治疗且失访而被排除。在剩余的 45 名患者中，有 33 名患者返回了问卷（73.3%）。SCS 植入时，72.7%的患者为男性，平均年龄为 58±8.5 岁。24 名患者为 III-IV 级心绞痛，9 名为 II-III 级纽约心脏协会（NYHA）分级。随访 6.4±4.1 年后，男性的体力活动能力更好，身体或情绪限制对 QoL 的影响更小（均 p<0.05）。无 COPD 的患者一般健康状况优于 rAP 合并 COPD 的患者（p<0.05）。DM 对 QoL 的影响呈边缘显著。BMI 较低的患者在情绪健康和疾病感知方面的评分优于 BMI 较高的患者（p<0.05 和 p<0.05）。无患者报告其他限制运动的合并症。
与女性相比，男性在接受 SCS 植入术后 QoL 改善更大。随着 SCS 改善 rAP，其他慢性合并症，如 COPD、DM 和 BMI，可能成为运动的限制因素，并随后对植入 SCS 系统后的 QoL 产生不利影响。鉴于本研究为相对较小的单中心研究，我们建议关于 rAP 和 SCS 的研究也应关注合并症对结局的影响。
